Yes, Say Gay: Small Steps to Improving LGBTQ+ Patient Care

Joel Wyatt, PhD


May 13, 2022

Legislation around LGBTQ+ education in schools made headlines recently after Florida Governor Ron DeSantis passed the "Don't Say Gay" bill, as it's come to be called by many. The legislation bars teachers and school systems from mentioning or instructing students in kindergarten through third grade on issues around sexual orientation and gender identity.

And with dozens of other states soon to follow behind, I believe that LGBTQ+-affirming healthcare is more important than ever. Policies that marginalize LGBTQ+ communities perpetuate and expand health inequities in several ways, from increases in cardiovascular disease risk to increases in depression and anxiety. Denying education in schools is the making of a snowball ready to roll down hill; allowing and supporting further healthcare discrimination could be right around the corner.

A recent study published by the LGBTQ Health and Human Services Network in Connecticut aimed at assessing LGBTQ+ healthcare needs found that 64% of LGBTQ+ patients have concerns about accessing healthcare. Health inequities in LGBTQ+ individuals are well documented and, yet, gender and sexually diverse patients are still falling through the cracks of our healthcare systems. Fear of discrimination, invalidating experiences in doctors' offices, and refusal of care prevent LGBTQ+ patients from accessing life-saving healthcare. Lack of routine visits cause ongoing health problems to go unnoticed and noticeable problems to get worse prior to intervention, which further burdens the healthcare system and its patients.

As a clinical psychologist and an ally, it pains me to see how repetitive patterns of discrimination and neglect within healthcare systems negatively impact the physical and mental well-being of the diverse people we are charged to serve. Some of the stories I've heard from patients are heartbreaking. One patient shared that their doctor intentionally misgendered them, emphasizing the wrong pronoun loudly while talking with nursing staff. Another noted being outright refused care for a foot problem when presenting to their PCP, with the doctor proclaiming, "I don't treat transgender people" after the patient recently came out of the closet. Despite practicing as a therapist for years, I had no words for those painful moments.

Fortunately, it isn't difficult to make meaningful changes without spending a dime or adding staff or resources. Even better, healthcare workers from every sector — administrative staff to physicians — can have a big impact.

I am talking about what experts call affirming healthcare, which starts simply with asking our patients more questions about their lives and preferences.

Research shows that nearly 50% of primary care physicians don't ask their patients about their gender or sexual identity. In my experience working in the field for more than 5 years, most doctors and healthcare workers believe that it is up to patients to bring up important issues.

However, how can we expect someone to share details so personal, and often a source of shame, discrimination, and fear, when we do not open the doors to show that we would welcome it? When healthcare workers make the extra effort to ask such personal questions, it proves to our patients that we are willing to listen, learn, and treat patients based on their individual needs and identities, not just treat symptoms of the day and move patients along like cattle.

Here are three simple steps any healthcare worker who interacts with patients can take, beginning today:

Learn about a patient's sexual orientation and gender identity. Start addressing people in ways they want to be addressed. Nearly 75% of transgender and nonbinary young-adult patients report being misgendered within healthcare systems, creating feelings of fear, isolation, and withdrawal from the healthcare system. Updating preferred pronouns and/or honorifics are easy fixes that can create environments of safety necessary to build trust with healthcare providers and systems.

Step outside of your comfort zone and ask about these sensitive topics. To be sure, we are bound to step into unfamiliar territories and make mistakes. However, when faced with information that we are unsure of, such as a new pronoun or identity, it is imperative that as professional healthcare givers we ask deeper questions and remain vigilantly curious about our patients. Keep in mind, it is not the responsibility of patients to educate us on all things LGBTQ+. Take time to ask, yet respect the boundaries that patients set and do your own research. When you make mistakes, own them and apologize. Culturally humble healthcare is better healthcare.

Commit to success. Failure to perform such simple tasks is harmful to patients and violates the core of ethics guidelines and oaths taken as a part of the helping professions. LGBTQ+ people often report avoidance of healthcare systems because of their identity and not knowing how they might be treated. For good reason, they fear the worst. Sadly, they neglect their healthcare and end up with dire health conditions unnecessarily.

The American healthcare system has historically failed LGBTQ+ patients. Lack of engagement and interest in the identities of patients by healthcare providers lead our LGBTQ+ patients to believe that they do not belong in healthcare settings, negatively impacting their physical and mental health.

As professionals, we are no longer tied to delivering subpar healthcare to LGBTQ+ patients. We can be better, and the solution can be as simple as opening the door for a discussion about gender and sexual identity to communicate that you are an affirming provider.

Joel Wyatt, PhD, is an assistant professor in the Rush University Department of Psychiatry and Behavioral Sciences and is a Public Voices Fellow through The OpEd Project.


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